|
|
 |
|
|
TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
Regional Summary for Region II for 2007
88 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
149,022,191 |
3,547,888 |
7,187,048 |
3,060,787 |
162,817,914 |
| 1b. Fee-for-Service revenue for Services |
92,251,730 |
7,426,169 |
3,646,114 |
24,312,707 |
127,636,720 |
| 1. Total revenue for Services (Lines
1a + 1b) |
241,273,921 |
10,974,057 |
10,833,162 |
27,373,494 |
290,454,634 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
102,749,859 |
191,692 |
|
|
102,941,551 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
32,322,633 |
222,658 |
|
|
32,545,291 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
8,788,662 |
856,399 |
423,657 |
2,998,717 |
13,067,435 |
| 3d. Penalties or paybacks to managed
care plans |
1,108,446 |
0 |
0 |
0 |
1,108,446 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
384,026,629 |
12,244,806 |
11,256,819 |
30,372,211 |
437,900,465 |
| Expenses |
| 5a. Capitation expenses for Services |
259,038,945 |
4,044,453 |
12,437,536 |
9,762,955 |
285,283,889 |
| 5b. Fee-for-Service expenses for Services |
132,466,437 |
8,551,946 |
7,948,379 |
48,322,917 |
197,289,679 |
5. Total expenses for Services
(Lines 5a + 5b) |
391,505,382 |
12,596,399 |
20,385,915 |
58,085,872 |
482,573,568 |
7. Total Managed Care Expenses
(Line 5) |
391,505,382 |
12,596,399 |
20,385,915 |
58,085,872 |
482,573,568 |
Surplus / Deficit
(Line 4 - Line 7) |
-7,478,753 |
-351,593 |
-9,129,096 |
-27,713,661 |
-44,673,103 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
- 1.9% |
- 2.8% |
- 44.8% |
- 47.7% |
- 9.3% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
5,793,036 |
68,706 |
320,172 |
213,448 |
6,395,362 |
| 8b. Member months for managed care (fee-for-service) |
962,022 |
89,236 |
121,166 |
642,382 |
1,814,806 |
8. Total Member months for managed care
(Lines 8a + 8b) |
6,755,058 |
157,942 |
441,338 |
855,830 |
8,210,168 |
| 9a. Managed Care Encounters (capitated) |
2,081,908 |
27,726 |
86,144 |
54,545 |
2,250,323 |
| 9b. Managed Care Encounters (fee-for-service) |
898,984 |
69,415 |
53,543 |
311,753 |
1,333,695 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
2,980,892 |
97,141 |
139,687 |
366,298 |
3,584,018 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
485,382 |
9,873 |
33,199 |
17,545 |
545,999 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
89,869 |
8,217 |
11,767 |
57,910 |
167,763 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
575,251 |
18,090 |
44,966 |
75,455 |
713,762 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
23 |
0 |
0 |
0 |
23 |
| 12. Number of Managed Care Contracts |
413 |
118 |
187 |
238 |
956 |
Data as of: 7/3/2008 11:22:17
|
